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County-level factors affecting Latino HIV disparities in the United States

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  • Nanette D Benbow
  • David A Aaby
  • Eli S Rosenberg
  • C Hendricks Brown

Abstract

Objective: To determine which county-level social, economic, demographic, epidemiologic and access to care factors are associated with Latino/non-Latino White disparities in prevalence of diagnosed HIV infection. Methods and findings: We used 2016 county-level prevalence rates of diagnosed HIV infection rates for Latinos and non-Latino Whites obtained from the National HIV Surveillance System and factors obtained from multiple publicly available datasets. We used mixed effects Poisson modeling of observed HIV prevalence at the county-level to identify county-level factors that explained homogeneous effects across race/ethnicity and differential effects for Latinos and NL-Whites. Overall, the median Latinos disparity in HIV prevalence is 2.4; 94% of the counties have higher rates for Latinos than non-Latinos, and one-quarter of the counties’ disparities exceeded 10. Of the 41 county-level factors examined, 24 showed significant effect modification when examined individually. In multi-variable modeling, 11 county-level factors were found that significantly affected disparities. Factors that increased disparity with higher, compared to lower values included proportion of HIV diagnoses due to injection drug use, percent Latino living in poverty, percent not English proficient, and percent Puerto Rican. Latino disparities increased with decreasing percent severe housing, drug overdose mortality rate, percent rural, female prevalence rate, social association rate, percent change in Latino population, and Latino to NL-White proportion of the population. These factors while significant had minimal effects on diminishing disparity, but did substantially reduce the variance in disparity rates. Conclusions: Large differences in HIV prevalence rates persist across almost all counties even after controlling for county-level factors. Counties that are more rural, have fewer Latinos, or have lower NL-White prevalence rates tend to have higher disparities. There is also higher disparity when community risk is low.

Suggested Citation

  • Nanette D Benbow & David A Aaby & Eli S Rosenberg & C Hendricks Brown, 2020. "County-level factors affecting Latino HIV disparities in the United States," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-23, August.
    • Handle: RePEc:plo:pone00:0237269
    DOI: 10.1371/journal.pone.0237269
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    References listed on IDEAS

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    3. Vaughan, A.S. & Rosenberg, E. & Shouse, R.L. & Sullivan, P.S., 2014. "Connecting race and place: A county-level analysis of White, Black, and Hispanic HIV prevalence, poverty, and level of urbanization," American Journal of Public Health, American Public Health Association, vol. 104(7), pages 77-84.
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